Abstract 17514: Prevalence and Clinical, Electrocardiographic and Electrophysiological Characteristics of Ventricular Arrhythmias Originating from the Non-coronary Cusp of the Aorta
Backgrounds- The aortic root is one of the major sites of idiopathic ventricular arrhythmias (VAs) origins. Some idiopathic VAs can be ablated from the non-coronary aortic cusp (NCC). The purpose of this study was to reveal the prevalence and clinical, electrocardiographic and electrophysiological characteristics of idiopathic NCC VAs.
Methods and Results- We studied 88 consecutive patients who underwent successful catheter ablation of idiopathic aortic root VAs (the left coronary cusp (LCC)=32, right coronary cusp (RCC)=32, junction between the LCC and RCC (L-RCC)=19 and NCC=5), which was confirmed by aortography and coronary angiography. The results are summarized in the table. NCC VAs occurred in significantly younger patients (all < 40 yo), and exhibited shorter QRS duration (all < 150 ms), smaller R wave amplitude ratio in the leads II and III (III/II), earlier ventricular activation in the His bundle (HB) region (all preceded the QRS onset by > 10 ms), larger atrial and ventricular electrogram amplitude ratio (A/V) at the successful ablation site (all > 1) than the other VAs. QRS morphology of NCC VAs was similar to that of RCC VAs, but NCC VAs always exhibited a left bundle branch block and left superior (n=1) or inferior axis (n=4) QRS morphology. All NCC VAs exhibited VTs although PVCs were dominant in the other VAs. The local ventricular activation time at the successful ablation site, and number of radiofrequency applications to achieve successful ablation did not significantly differ among the aortic root VAs.
Conclusions- NCC VAs were very rare (6%) and occurred in significantly younger patients among the aortic root VAs. Electrocardiographic and electrophysiological characteristics of NCC VAs were similar to those of RCC VAs, but were characterized by narrower QRS duration, smaller III/II ratio, earlier ventricular activation in the HB region, and > 1 of A/V ratio at the successful ablation site.
- © 2012 by American Heart Association, Inc.